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Difficulty: MediumBasic Care and Comfort

An adult client is transferred to the medical-surgical unit 4 hours after a subtotal thyroidectomy. The client reports mild neck discomfort and difficulty swallowing. To promote comfort, minimize tissue swelling, and reduce tension on the surgical site, which position is most appropriate for the nurse to assist the client into?

  1. A
    Supine position with a small rolled towel placed directly under the cervical spine
  2. B
    High Fowler's position with the neck slightly hyperextended to open the airway
  3. C
    Side-lying position with the head of the bed flat to prevent sudden blood pressure drops
  4. Semi-Fowler's position with pillows supporting the head and neck in neutral alignmentAnswer

Answer

Semi-Fowler's position with pillows supporting the head and neck in neutral alignment
Following a thyroidectomy, placing the client in a Semi-Fowler's position (head of the bed elevated 30 to 45 degrees) with the head and neck supported by pillows in a neutral position is the standard of care. The elevation minimizes tissue edema and swelling that could compromise the airway, while the neutral alignment prevents stretching or tension on the surgical incision, thereby reducing pain and the risk of wound separation.

Step-by-Step Solution

1
Analyze the client's postoperative status and the anatomical location of the surgery (subtotal thyroidectomy).
Recognize that the surgical site is in the anterior neck, making the airway highly vulnerable to compression from swelling.
Identifying the specific risks of the procedure (edema, airway compromise, and bleeding) is essential before selecting a comfort intervention.
2
Determine the optimal degree of bed elevation.
Select a Semi-Fowler's position (head of bed elevated 30 to 45 degrees).
Elevating the upper body uses gravity to promote venous return, which decreases tissue swelling and edema around the airway and incision.
3
Determine the optimal alignment for the cervical spine.
Ensure the head and neck are supported in a neutral alignment using pillows.
Maintaining a neutral position prevents neck flexion or hyperextension, both of which place dangerous tension on the fresh suture line and cause discomfort.

Key Concept

Postoperative Positioning for Neck Surgery
Estimated Time:1m 0s
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Topics

Basic Care and Comfort

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